再次心脏手术二尖瓣替换术77例临床分析  

Reoperations on mitral valve replacement in 77 cases

作　　者：王学锋[1] 肖颖彬[1] 陈林[1] 钟前进[1] 陈柏成[1] 陈劲进[1] 刘兵[1] 曾祥君[1] 

机构地区：[1]第三军医大学附属新桥医院心血管外科,重庆400037

出　　处：《第三军医大学学报》2002年第3期328-329,共2页Journal of Third Military Medical University

摘　　要：目的　报告再次心脏手术二尖瓣替换术 77例的治疗经验。方法　 77例中二尖瓣闭式扩张术后再狭窄 5 6例 ,生物瓣替换术后瓣膜毁损 15例 ,机械瓣替换术后瓣膜功能障碍 4例 ,部分房室管畸形术后二尖瓣关闭不全 1例 ,房间隔缺损术后风湿性二尖瓣病变 1例。 5 5例在体外循环心脏停搏下手术 ,2 2例在浅低温体外循环心脏跳动下进行手术。结果　手术早期死亡 4例 (死亡率 5 2 % )。晚期死亡 2例。随访存活病人心功能明显改善。结论　病人术前心功能是导致再次手术二尖瓣替换术后并发症和死亡率的重要因素 ,心脏跳动下进行手术可简化手术过程 ,改善心肌保护 。Objective To review the reoperations on mitral valve replacement in 77 cases. Methods In the 77 cases of reoperations 56 suffered from restenosis after closed mitral commissarotomy, 15 with structural destruction after bioprosthese replacement, 1 with severe mitral valve incompetence after repair for partial atrioventricular canal defect, and 1 with rheumatic mitral valve diseases after repair for atrial septal defect. Fifty five cases were undergone mitral valve replacements on arrested heart with moderate hypothermic cardiopulmonary bypass, and the others on beating heart with mild hypothermic cardiopulmonary bypass. Results The early stage postoperative mortality was 5.2% (4 of 77 cases), 2 patients died during following up period. The cardiac function states in the survivors were significantly improved. Conclusion The preoperative cardiac function states are the major detrimental factor predisposing postoperative convalescences. Reoperations on mitral valve replacement on beating heart might fascinate operation, and ameliorate myocardial ischemic reperfusion injury during operation.

关 键 词：再次心脏手术 二尖瓣替换 心脏不停跳 临床分析 

分 类 号：R654.2[医药卫生—外科学]